<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html dir="ltr" xmlns="http://www.w3.org/1999/xhtml">
<%@include file="/WEB-INF/taglibs/common/taglibs.jsp" %>

<head>
    <title><spring:message code="sp.request_blank_check.title"/></title>
    <meta content="text/html; charset=utf-8" http-equiv="Content-Type"/>
    <link rel="stylesheet" href="<c:url value="/css/styles.css"/>"/>  
    <link rel="stylesheet" href="<c:url value="/css/calendar-system.css"/>"/>
    <script src="<c:url value="/javascripts/common.js"/>"></script>
</head>

<body>
<div class="page">
<link
		href='<%=request.getContextPath()%>/WEB-INF/jsp/serviceprovider/check/jquery-ui-1.css'
			rel="stylesheet" type="text/css">
<%@include file="../../top_menu.jsp"%>
			<table width="100%">
    <tr>
        <td>
            <c:import url="/WEB-INF/jsp/menu/checks_menu.jsp"/>
        </td>
    </tr>
    <tr>
        <td>
            <c:import url="/WEB-INF/jsp/menu/blank_checks_menu.jsp"/>
        </td>
    </tr>
    <tr>
        <td>
            <%@include file="/WEB-INF/jsp/include/messages.jsp" %>
            <br/>
        </td>
    </tr>
    <tr>
        <td>
            <form id="role" method="post" action="/serviceprovider/check/blank_check/blank_checks.htm">

                <table class="formTable" width="84%">
                    <tbody>
                    <tr class="formHeader">
                        <td colspan="5"><spring:message code="sp.request_blank_check.label.title"/></td>
                    </tr>
                    <tr>
                        <td width="21%"><spring:message code="sp.request_blank_check.label.no_of_checks"/></td>
                        <td width="25%"><input type="text" name="textfield2"/></td>
                        <td colspan="2"><spring:message code="sp.request_blank_check.label.preauthorized.1"/>
                            <input type="text" name="textfield" width="50px"/>
                            <spring:message code="sp.request_blank_check.label.preauthorized.2"/>
                        </td>
                    </tr>
                    <tr>
                        <td height="36" colspan="4"><spring:message
                                code="sp.request_blank_check.label.preauthorized.message.1"/>
                        </td>
                    </tr>
                    <tr>
                        <td height="36" colspan="2"><spring:message
                                code="sp.request_blank_check.label.preauthorized.increase.message"/></td>
                        <td width="28%"><input type="checkbox" name="cb1" value="cb1"/></td>
                        <td width="26%">&nbsp;</td>
                    </tr>
                    <tr>
                        <td height="76"><spring:message
                                code="sp.request_blank_check.label.preauthorized.increase.limit"/></td>
                        <td><input type="text" name="textfield22"/></td>
                        <td><spring:message code="sp.request_blank_check.label.reason"/></td>
                        <td><textarea name="textarea"></textarea></td>
                    </tr>
						<tr>
							<td height="35">
								<spring:message
						code="sp.request_blank_check.label.verify_mailing_address"/>
							</td>
						</tr>
                                <tr>
									<td height="35">
										Mailing Address 1: <input name="radiobutton" type="radio" value="radiobutton" checked="checked" />
									</td>
									<td>Street Address</td>
									<td>
										<input type="text" name="textfield223" />
									</td>
									<td>&nbsp;</td>
									<td>
										<input type="text" name="textfield22422" />
									</td>
								</tr>
								<tr>
									<td height="35">&nbsp;</td>
									<td>City</td>
									<td>
										<input type="text" name="textfield22322" />
									</td>
									<td>State/Province</td>
									<td>
										<input type="text" name="textfield2233" />
									</td>
								</tr>
								<tr>
									<td height="35">
										Mailing Address 2:
										<input name="radiobutton" type="radio" value="radiobutton" />
									</td>
									<td>Street Address</td>
									<td>
										<input type="text" name="textfield223" />
									</td>
									<td>&nbsp;</td>
									<td>
										<input type="text" name="textfield22423" />
									</td>
								</tr>
								<tr>
									<td height="35">&nbsp;</td>
									<td>City</td>
									<td>
										<input type="text" name="textfield22322" />
									</td>
									<td>State/Province</td>
									<td>
										<input type="text" name="textfield2233" />
									</td>
								</tr>
								<tr>
									<td height="35">
										Mailing Address 3:
										<input name="radiobutton" type="radio" value="radiobutton" />
									</td>
									<td>Street Address</td>
									<td>
										<input type="text" name="textfield223" />
									</td>
									<td>&nbsp;</td>
									<td>
										<input type="text" name="textfield2242" />
									</td>
								</tr>
								<tr>
									<td height="35">&nbsp;</td>
									<td>City</td>
									<td>
										<input type="text" name="textfield22322" />
									</td>
									<td>State/Province</td>
									<td>
										<input type="text" name="textfield2233" />
									</td>
								</tr>
								<tr>
									<td height="37">&nbsp;</td>
									<td>&nbsp;</td>
									<td>&nbsp;</td>
									<td>&nbsp;</td>
									<td>&nbsp;</td>
								</tr>
                    <tr>
                        <td height="37"><spring:message code="sp.request_blank_check.label.prev_checks"/></td>
                        <td><select name="select">
                            <option value="1" selected="selected">Used All</option>
                            <option value="2">Last Shipment was lost</option>
                            <option value="3">Ordering before i finish all</option>
                            <option value="4">Other reason</option>
                        </select></td>
                        <td><spring:message code="sp.request_blank_check.label.reason_detail"/></td>
                        <td><textarea name="textarea2"></textarea></td>
                    </tr>
                    <tr>
                        <td height="37"><input onclick="javascript:document.getElementById('shipment_history').style.display='block';return false;" class="ui-button ui-state-default ui-corner-all"
                                               value='<spring:message code="sp.request_blank_check.label.send_request"/>'
                                               type="submit"></td>
                        <td>&nbsp;</td>
                        <td>&nbsp;</td>
                        <td>&nbsp;</td>
                    </tr>
                <table id="shipment_history" class="formTable" cellspacing="0" width="84%">
                    <tbody>
                    <tr class="formHeader">
                        <td colspan="5"><spring:message code="sp.request_blank_check.label.history"/></td>
                    </tr>
                    <tr>
                        <td width="7%"><a href="#"><span style="cursor: pointer; width: 5.5em; color: black;"
                                                         class="headerLink"></span><b><spring:message
                                code="sp.request_blank_check.label.sr_no"/></b></a></td>
                        <td width="12%"><a href="#"><span style="cursor: pointer; width: 5.5em; color: black;"
                                                          class="headerLink"></span><b><spring:message
                                code="sp.request_blank_check.label.request_id"/></b></a></td>
                        <td width="13%"><a href="#"><span style="cursor: pointer; width: 5.5em; color: black;"
                                                          class="headerLink"></span><b><spring:message
                                code="sp.request_blank_check.label.request_date"/></b></a></td>
                        <td width="15%"><a><span style="cursor: pointer; width: 5.5em; color: black;"
                                                 class="headerLink"></span></a><a href="#"><b><spring:message
                                code="sp.request_blank_check.label.checks_ordered"/></b></a></td>
                        <td width="11%"><a href="#"><span style="cursor: pointer; width: 5.5em; color: black;"
                                                          class="headerLink"></span><b>
                            <spring:message code="sp.request_blank_check.label.status"/></b></a></td>
                    </tr>
                    </tbody>
                    <input id="usersList[0].id" name="usersList[0].id" value="28" type="hidden"/>
                    <input name="usersId" value="28" type="hidden"/>
                    <tr>
                        <input id="usersList[0].email" name="usersList[0].email" value="bbb@gmail.com"
                               type="hidden"/>
                        <td>1</td>
                        <td>1000</td>
                        <td>1/12/2012</td>
                        <td>12</td>
                        <td><a href="http://www.fedex.com/">In process</a></td>
                    </tr>
                    <input id="usersList[1].id" name="usersList[1].id" value="27" type="hidden"/>
                    <input name="usersId" value="27" type="hidden"/>
                    <tr>
                        <input id="usersList[1].email" name="usersList[1].email" value="aaa@gmail.com"
                               type="hidden"/>
                        <td>2</td>
                        <td>1001</td>
                        <td>1/2/2012</td>
                        <td>15</td>
                        <td><a href="http://www.usps.com/">In process</a></td>
                    </tr>
                    <input id="usersList[2].id" name="usersList[2].id" value="26" type="hidden"/>
                    <input name="usersId" value="26" type="hidden"/>
                    <tr>
                        <input id="usersList[2].email" name="usersList[2].email" value="payee22@gmail.com"
                               type="hidden"/>
                        <td>3</td>
                        <td>1002</td>
                        <td>5/2/2011</td>
                        <td>20</td>
                        <td><a href="http://www.usps.com/">In process</a></td>
                    </tr>
                    <input id="usersList[3].id" name="usersList[3].id" value="25" type="hidden"/>
                    <input name="usersId" value="25" type="hidden"/>
                    <input id="usersList[4].id" name="usersList[4].id" value="24" type="hidden"/>
                    <input name="usersId" value="24" type="hidden"/>
                    <tr>
                        <input id="usersList[4].email" name="usersList[4].email" value="payee20@gmail.com"
                               type="hidden"/>
                        <td>4</td>
                        <td>1004</td>
                        <td>2/4/2010</td>
                        <td>15</td>
                        <td><a href="http://www.ups.com/">In process</a></td>
                    </tr>
                    <input id="usersList[5].id" name="usersList[5].id" value="23" type="hidden"/>
                    <input name="usersId" value="23" type="hidden"/>
                    <tr>
                        <td>&nbsp;</td>
                        <td>&nbsp;</td>
                        <td>&nbsp;</td>
                        <td>&nbsp;</td>
                        <td>&nbsp;</td>
                    </tr>
                    <tr>
                        <td colspan="4"><spring:message code="sp.request_blank_check.label.history.message"/>
                        </td>
                        <td><input name="submit" type="submit" class="ui-button ui-state-default ui-corner-all"
                                   value='<spring:message code="sp.request_blank_check.label.yes"/>'/>
                            <input name="submit2" type="submit" onclick="javascript:document.location.href='/serviceprovider/spHome.htm';return false;" class="ui-button ui-state-default ui-corner-all"
                                   value='<spring:message code="sp.request_blank_check.label.no"/>'/></td>
                    </tr>
                    <tr>
                        <td colspan="5">&nbsp;</td>
                    </tr>
                    <tr>
                        <td height="20" colspan="5"><a href="#"><spring:message
                                code="sp.request_blank_check.label.order_history"/></a></td>
                    </tr>
                    <tr>
                        <td height="20" colspan="5"><font color="#C400C4"><spring:message
                                code="sp.request_blank_check.label.warning"/></font></td>
                    </tr>
                </table>

            </form>
        </td>
    </tr>
    </tbody>
</table>

<div class="contentArea">
</div>
</div>
<%@include file="/WEB-INF/jsp/include/footer.jsp" %>
</table>
</body>
</html>